To Really Know the Disease: Creating a Participatory Community Education Workshop about Taenia solium Focused on Physical, Economic, and Epidemiologic Evidence.

Cysticercosis, caused by Taenia solium, is a neglected disease that causes preventable epilepsy. We conducted an experiential learning workshop in northern Peru to educate community members on T. solium transmission and motivate participation in community-led prevention and control. The workshop included presentation of local economic and epidemiologic data, followed by hands-on participation in pig dissection, group discussion of the T. solium life cycle, and viewing of eggs and nascent tapeworms with light microscopes. Among heads of household, we used community survey data to compare knowledge of the three-stage parasite life cycle at baseline and 2 months postworkshop. Knowledge of the life cycle increased significantly after the workshop, with greater gains for workshop attendees than non-attendees. Prior knowledge and workshop attendance were significant predictors of postworkshop knowledge. The use of local evidence and experiential learning positively affected knowledge of T. solium transmission, laying the foundation for subsequent community-engaged control efforts.

Evaluating Urban Taeniasis as a Threat to Cysticercosis Elimination in Northern Peru.

Reintroduction of Taenia solium into a region in Peru where it had been eliminated prompted evaluation of the possibility of reintroduction from an urban reservoir of taeniasis. In a cross-sectional study of an adjacent urban area, we found low prevalence of taeniasis (4/1,621; 0.25%), suggesting minimal risk of parasite reintroduction into rural areas through this route.

Barriers to Participation in a Community-Based Program to Control Transmission of Taenia solium in Peru.

Infection of the brain with Taenia solium larvae (neurocysticercosis) is a leading cause of preventable epilepsy worldwide. Effective and sustainable strategies to control parasite transmission in rural endemic communities are needed to prevent the disease. Surveillance and targeted intervention around infected pigs (ring control strategy) have been shown to be effective when carried out by research teams. However, this strategy has not been implemented or tested as a community-based program. In this small trial in northern Peru, eight villages were randomly assigned to community-led surveillance and treatment (five villages, 997 residents) or control (three villages, 1,192 residents). In intervention villages, community-led surveillance and reporting were promoted by community health workers, radio advertisement, and school and household education. Each suspected pig infection was verified, with confirmed cases resulting in treatment with niclosamide for taeniasis and oxfendazole for pigs in clusters of homes nearby. No incentives beyond human and pig treatment were offered. Control villages received basic disease education but no treatment intervention in response to reports. Despite 14 case reports, community-based replication of ring control strategy did not replicate prior results. After 12 months, there was no change in seroincidence in intervention villages between the baseline and study end, and no difference compared with control villages. There was no difference in prevalence of taeniasis or porcine cysticercosis at study end. Community members described lack of knowledge as the main reason for not reporting infected pigs. Further exploration of methods to transfer ring strategy and other control interventions for cysticercosis to the community is needed.

Sirtuins regulate proteomic responses near thermal tolerance limits in the blue mussels Mytilus galloprovincialis and Mytilus trossulus.

The blue mussels Mytilus galloprovincialis and M. trossulus are competing species with biogeographical ranges set in part by environmental exposure to heat and hyposalinity. The underlying cellular mechanisms influencing interspecific differences in stress tolerance are unknown, but are believed to be under regulation by sirtuins, nicotinamide adenine dinucleotide (NAD+)-dependent deacylases that play a critical role in the cellular stress response. A comparison of the proteomic responses of M. galloprovincialis and M. trossulus to an acute heat shock in the presence and absence of the sirtuin inhibitor suramin (SIRT1, 2 and 5) showed that sirtuins affected molecular chaperones, oxidative stress proteins, metabolic enzymes, cytoskeletal and signaling proteins more in the heat-sensitive M. trossulus than in the heat-tolerant M. galloprovincialis Interactions between sirtuin inhibition and changes in the abundance of proteins of ß-oxidation and oxidative stress in M. trossulus suggest a greater role of sirtuins in shifting metabolism to reduce the production of reactive oxygen species near thermal limits. Furthermore, RNA-binding proteins initiating and inhibiting translation were affected by suramin in M. galloprovincialis and M. trossulus, respectively. Western blot analysis showed that the levels of mitochondrial sirtuin 5 (SIRT5) were generally three times higher and increased with acute heat stress in response to sirtuin inhibition in M. trossulus but not in M. galloprovincialis, suggesting a possible feedback response in the former species and a greater reliance on SIRT5 for its stress response. Our findings suggest that SIRT5 plays an important role in setting interspecific differences in stress tolerance in Mytilus by affecting the stress proteome.

Failure of lung isolation by a double-lumen endotracheal tube rescued by the concomitant use of an arndt bronchial blocker under direct visualization.

Failure of a double-lumen endotracheal tube (DLT) to isolate the lung during thoracic surgery can have significant consequences. In this report, we examine an approach for rescuing a malpositioned DLT. A 37F left-sided DLT was inserted and its proper position confirmed. After positioning, repeat confirmation of position and the ability to achieve 1-lung ventilation were performed, but inadequate isolation of the lung being operated on was noted after incision. A 7-Fr Arndt bronchial blocker was positioned through the tracheal lumen of the DLT to obtain 1-lung ventilation. This technique can be used to rescue a malfunctioning DLT without the need for extubating and reintubating the trachea.